INDIAN RIVER VETERINARY HOSPITAL

POLICIES AND PROCEDURES AGREEMENT 

Financial Policy  

All payments are due at the time of service. I accept responsibility for payment for services provided. I will be responsible for payment by cash, check or credit card on the day of service. Outstanding account balances must be resolved prior to additional services being rendered.  Clients who do not comply with established payment plans or who do not resolve outstanding balances within three statement cycles will be unable to schedule an appointment until the balance is resolved and may be dismissed from the practice.  

Returned Checks 

There is a $35.00 fee for any check returned by your bank. 

Missed/ Late Appointment Policy

Every effort is made to keep the Doctor’s schedule on time; therefore, if you are more than 15 minutes late we cannot guarantee that you will be seen, and may be asked to reschedule your appointment.  

Missed/Cancelled Appointments & Procedures Fees

Every effort is made to accommodate our patients’ requests for appointments and procedure dates/times; therefore, it is important that you make every effort to keep your scheduled appointments. No shows and appointments for Saturday office visits cancelled within 24 hours may be subject to a fee of $44.00. Cancellation of a scheduled procedure within 24 hours may also be subject to a cancellation fee of $100.00. To cancel an office visit or procedure please call our office at 757-420-2277. Please be advised that multiple missed appointments may result in dismissal from our practice. 

Medication Policy/Prescription Refill Policy

For all medication refills, please contact our office to request refills at 757-420-2277. Please allow 24 hours’ notice on all requests. If your pet has not been seen in our office within the last 12 months, your pet is required to be seen prior to refills being approved. Our doctors will not approve electronic or faxed medication requests from internet pharmacies. If you wish to have your pet’s medication filled through an outside pharmacy we will gladly provide you with a written prescription at your request. A fee may be associated with some written prescriptions. 

Urgent/Emergency Care Policy

Dr. Bracy is currently the only veterinarian at Indian River Veterinary hospital. If your pet is experiencing an emergency, please call us at 757-420-2277 during normal business hours. On days when our schedule is fully booked, our staff will do our best to coordinate the care of your pet.  If the schedule permits, we will instruct you to bring your pet into the office. Based on the pet’s symptoms, our staff may advise you to proceed to the nearest emergency veterinary facility. Please refer to our website or answering message for the most up to date information of the recommended local veterinary emergency facilities. 

Consent for Treatment 

I hereby authorize Indian River Veterinary Hospital to use and/or disclose my pet’s health information to carry out his/her treatment, obtain payment, and conduct healthcare operations. I understand this consent is voluntary. I understand I have the option to choose another veterinary facility for my pet. 

Medical Records Policy/Transferring of Records

All patients will be given a one-time courtesy record transfer via fax or email. Additional record requests may include an administration fee. Printed paper copies can be provided by request but include a printing fee. Please allow 72 hours notice for completion of your request to allow for our doctor to review and approve the release of your pet’s records.  

Patients with Pet Insurance Statement

I authorize release of medical information about me or my pet to be released to an authorized insurance company and it’s agents for determination of benefits or benefits payable for related veterinary services. 

Electronic Medical Records

In compliance with the United States government mandate to promote the use of electronic medical records, this practice utilizes a securely encrypted electronic medical record system. I consent to allow this system to store and retrieve my pet’s medical and medication history as needed. 

Photography, Audio and Video Recording

Clients are prohibited from taking photographs or recording audio or video of their pet receiving veterinary services or an employee without the expressed and written permission of management. For security and education purposes, photographs, audio or video recording may occur of you and your pet during your visit. 

Privacy Practice Policy/Notice of Privacy Acknowledgment or Receipt

I have been informed that Indian River Veterinary Hospital has a Notice of Privacy Practices, which fully described how they will use and disclose my pet’s health information and that a copy of this is posted in the waiting room and that there are copies available for my review. 

By signing this form, I acknowledge and agree to all items listed above.